MCS. Tuesday, April 10, 2018 Athena. In Mechanical Circulatory Support. Scientific Program Committee. Faculty ISHLT ACADEMY CORE COMPETENCIES

Transcription

1 ISHLT ACADEMY In Mechanical Circulatory Support Tuesday, April 10, 2018 Athena 8:00 am 5:30 PM Scientific Program Committee CHAIR: CO-CHAIR: CO-CHAIR: Faculty Diyar Saeed, MD, PhD, Heinrich-Heine University, Dusseldorf, Germany Hospital, Falls Church, VA, USA Jennifer Cook, MD, University of Arizona Heart Center, Tucson, AZ, USA Saima Aslam, MD, MS, USCD Medical Center, San Diego, CA, USA Jennifer Cook, MD, University of Arizona Heart Center, Tucson, AZ, USA Michael Dickinson, MD, Spectrum Health, Grand Rapids, MI, USA Jonathan Haft, MD, University of Michigan, Ann Arbor, MI, USA Douglas Horstmanshof, MD, Integris Baptist Medical Center, Oklahoma City, OK, USA Susan M. Joseph, MD, Baylor University Medical Center, Dallas, TX, USA Antonio Loforte, MD, PhD, S. Orsola Hospital, Bologna, Italy Nader Moazami, MD, NYU Langone Medical Center, New York, NY, USA Kavitha Muthiah, MBchB, St. Vincent s Hospital, Sydney, Australia Samer Najjar, MD, Medstar Heart Institute, Washington, DC, USA Evgenij Potapov, MD, PhD, Deutsches Herzzentrum, Berlin, Germany Vivek Rao, MD, PhD, Toronto General Hospital, Toronto, ON, Canada Ryan Tedford, MD, Medical University of South Carolina, Charleston, SC, USA Diyar Saeed, MD, PhD, Heinrich-Heine University, Dusseldorf, Germany Christopher Salerno, MD, St Vincent Heart Center of Indiana, Indianapolis, IN, USA Thomas Schloeglhofer, BSc, Medical University of Vienna, Vienna, Austria Stephan Schueler, MD, PhD, FRCS, Newcastle Upon Tyne Hospital, Newcastle Upon Tyne, United Kingdom Hospital, Falls Church, VA, USA Lynne Warner Stevenson, MD, Brigham & Women s Hospital, Boston, MA, USA [ 66 ]

2 Course Summary The purpose of this Core Competency Course is to provide a concise review of clinical knowledge and outline of the essential professional skills for candidate assessment and longitudinal support for mechanical circulatory support patients. This course should serve programs providing mechanical circulatory support with a tool to review their standards of care, develop protocols, and implement guidelines established in management of mechanical circulatory support patients. The course consists of six plenary sessions; in the first session, the current state of mechanical circulatory support systems is reviewed, followed by the challenging task of adequate patient selection and preoperative preparation including proper assessment tools of right ventricular function. In the third session, all surgical aspects and alternative approaches of assist device implantation are addressed, followed by immediate postoperative care related issues and management of right ventricular insufficiency. The fifth session addresses the preparation strategies for proper and safe patient transition to home. In the final session, adequate management of device related long term complications are presented. Practice Gaps The field of the mechanical circulatory support systems has experienced steady growth during the last years. The management of these complex patients remains challenging and starts prior to the surgical procedures. There is still a lack of adequate knowledge of proper patient selection, right ventricular assessment, and proper management of device-related complications. This course will address all important aspects in the management of these patients starting from patient selection and preparation for the assist device implantation. Further, several alternative implantation approaches and surgical pitfalls are presented. Finally, issues related to the home transition and adequate state of art management strategies of assist device related complication management are addressed. Target Audience While all members are invited to enroll, this course is primarily designed to benefit clinicians and allied professionals who are in the early stages of their careers, are in training and/or are part of a new program, or desire an update on the current state of the field. The information presented covers core competencies and is intended to provide a strong foundation of the overarching principles of mechanical support, rather than a detailed update for those who are already proficient experts in the field. Educational Need This course is designed to meet the practitioner s educational need for a targeted review of clinical knowledge and essential professional skills to facilitate best practice of surgical and medical aspects involved in the care of patients with mechanical circulatory support devices. [ 67 ]

3 Learning Objectives At the conclusion of this course, participants will have improved competence and professional performance in their ability to: 1. Explain how to risk stratify patients with advanced heart failure in order to assess MCS surgical risk and optimally time mechanical circulatory support (MCS) implantation. 2. Discuss the medical and social factors which impact patient outcomes during short- and long-term MCS. 3. Recognize the various types of MCS support available for patients with advanced single or biventricular heart failure and the technological differences that may impact pump selection and patient/device management. 4. Identify MCS implantation techniques and patient/pump management during the index admission intensive care unit and inpatient general care periods. 5. Describe how to manage patients and the MCS during outpatient long-term support with an understanding of interventions that can reduce patient- and device-related adverse events during MCS. 6. Diagnose and manage common clinical dilemmas and adverse events encountered after MCS. Accreditation Statement The International Society for Heart and Lung Transplantation (ISHLT) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Credit Designation Statement ISHLT designates this live activity for a maximum of 8.00 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. ANCC Credit AMEDCO is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. This course is co-provided by AMEDCO and ISHLT. Maximum of 8.00 contact hours. Disclosure Current guidelines state that participants in CME activities must be made aware of any affiliation or financial interest that may affect the program content or a speaker s presentation. Planners, Faculty and Chairs participating in this meeting are required to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentations or service as Chair/Planner. These disclosures will be distributed at the meeting. Additionally, all speakers have been asked to verbally disclose at the start of their presentation if a product they are discussing is not labeled for the use under discussion or is still investigational. [ 68 ]

4 Scientific Program SCHEDULE 7:00 AM 8:00 AM REGISTRATION AND MORNING COFFEE 8:00 AM 8:05 AM WELCOME AND OVERVIEW Diyar Saeed, MD, PhD, Heinrich-Heine University, Dusseldorf, Germany 8:05 AM 9:15 AM SESSION 1: REVIEW OF THE CURRENT STATE OF MCS Chair: Diyar Saeed, MD, PhD 8:05 AM MCS Technology 101 Evgenij Potapov, MD, PhD, Deutsches Herzzentrum, Berlin, Germany Review of current technologies available Pump behaviors with different loading conditions TAH 8:25 AM BTT and DT Outcome Lynne Warner Stevenson, MD, Brigham & Women s Hospital, Boston, MA, USA Outcomes with current technologies Adverse events with current technologies 8:40 AM Short-term Support and Shock Jonathan Haft, MD, University of Michigan, Ann Arbor, MI, USA Percutaneous technologies Biventricular support considerations ECMO 9:00 AM Q&A with panel 9:15 AM 10:30 AM SESSION 2: PATIENT SELECTION Chair: Palak Shah, MD, MS 9:15 AM When Should Patients be Referred: Warning Signs Douglas Horstmanshof, MD, Integris Baptist Medical Center, Oklahoma City, OK, USA Risk factors which presage patient decline (renal function, intolerance of medications, hospitalizations Risk stratification of patients based on HF severity and MCS operative risk (case based) 9:35 AM Assessing and Optimizing RV Function Preoperatively Ryan Tedford, MD, Medical University of South Carolina, Charleston, SC, USA Impact of RV failure Pre-operative assessment and management of the RV including imaging and risk prediction (case based) 9:55 AM Quality of Life After VAD and the Impact of Frailty and Social Behaviors on VAD Success Susan M. Joseph, MD, Baylor University Medical Center, Dallas, TX, USA Factors that can have a significant impact on success after VAD Screening tools available for risk assessment 10:15 AM Q&A with panel 10:30 AM 10:45 AM COFFEE BREAK 10:45 AM NOON SESSION 3: SURGICAL CONSIDERATIONS Chair: Diyar Saeed, MD, PhD 10:45 AM Key Surgical Aspects of Implantation Nader Moazami, MD, NYU Langone Medical Center, New York, NY, USA Inflow cannula/pump placement Intraoperative considerations Driveline tunneling Optimal outflow graft anastamose Surgical tips and tricks 11:05 AM How Much Else is Too Much? Stephan Schueler, MD, PhD, FRCS, Newcastle Upon Tyne Hospital, Newcastle Upon Tyne, United Kingdom Management of aortic valve insufficiency Approach to tricuspid and mitral valve insufficiency Challenges like prior Dor procedures and Congenitals 11:25 AM Tailoring Pumps to Patients Diyar Saeed, MD, Heinrich-Heine University, Dusseldorf, Germany Considerations for pump-patient matching Different approaches for VAD implantation Advantages and disadvantages of minimal invasive approaches Off-Pump vs. On-Pump VAD implantation options 11:45 AM Q&A with panel NOON 1:00 PM LUNCH BREAK (a box lunch is included in the registration fee) [ 69 ]

5 1:00 PM 2:15 PM SESSION 4: POSTOPERATIVE CARE Chair: Jennifer Cook, MD 1:00 PM Managing the RV Postop Christopher Salerno, MD, St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA Considerations for impact of LVAD pump speed on RV function Use of inotropes, pulmonary vasodilators and temporary RV support postoperatively 1:20 PM Anticoagulation and Antiplatelet Therapy Vivek Rao, MD, PhD, Toronto General Hospital, Toronto, ON, Canada When to start anticoagulation and antiplatelet therapy regimens Data on platelet function testing and heparin level monitoring 1:40 PM Pump Speed Optimization: The Role of Imaging and Hemodynamics How to meld imaging and hemodynamics to optimize pump settings Highlight early and late postoperative pump speed considerations Define the role of echocardiography to evaluate underlying hemodynamics and optimize the pump speed to curb smoldering heart failure 2:00 PM Q&A with panel 2:15 PM 3:15 PM SESSION 5: TRANSITION TO HOME Chair: Jennifer Cook, MD 2:15 PM VAD Education: Patient/ Caregiver Assessments and Strategies for Successful VAD Self-Care Thomas Schloeglhofer, BSc, Medical University of Vienna, Vienna, Austria Approaches to education of the patient and caregiver prior to discharge Strategies for educating the local medical community 2:30 PM Starting New: How to Start and Succeed in MCS Michael Dickinson, MD, Spectrum Health, Grand Rapids, MI, USA Challenges of starting a VAD program Key elements of success 2:45 PM Optimal Outpatient Management of VAD Recipients Antonio Loforte, MD, PhD, S. Orsola Hospital, Bologna, Italy Lab Blood pressure monitoring Echo monitoring 3:00 PM Q&A with panel 3:15 PM 3:30 PM COFFEE BREAK 3:30 PM 5:20 PM SESSION 6: LONG TERM MANAGEMENT OF PATIENTS AND COMPLICATIONS A case based session Chair: Palak Shah, MD, MS 3:30 PM LVAD Infections: Prevention, Diagnosis and Management Saima Aslam, MD, MS, UCSD Medical Center, San Diego, CA, USA VAD infections Radiology studies important for diagnosis Therapeutic recommendations 3:50 PM Stroke: Risk Factors for Hemorrhagic and Embolic CNS Complications and Management Strategies Samer Najjar, MD, Medstar Heart Institute, Washington, DC, USA Diagnosis Risk factors Management strategies 4:10 PM Pump Thrombosis: Diagnostic Strategies and Management Algorithms Frequency, diagnosis, and management strategies for suspected pump thrombosis 4:30 PM Aortic Insufficiency in LVAD Recipients: Incidence, Screening and Management Jennifer Cook, MD, University of Arizona Heart Center, Tucson, AZ, USA Cumulative incidence Clinical consequences Management of AI after LVAD 4:50 PM GI Bleeding Kavitha Muthiah, MBchB, St. Vincent s Hospital, Sydney, Australia Frequency, diagnosis and management of GI bleeding after LVAD therapy New data on octreotide 5:10 PM Q&A with panel 5:20 PM COURSE SUMMARY AND ASSESSMENT 5:30 PM ADJOURN [ 70 ]